Thyroid UK

Hashimoto and thyroid medication

First of all I apologize if this is a really stupid question but I'm feeling really fuzzy brained at the moment and I can't seem to able to figure this out.

Ok so if you are hypo you take meds to help you. If you're hyper I assume you take different meds? If I understand how Hashi works you tend to swing from hypo to hyper making your tft vary greatly. So say that you have hashi and eventually you go for bloods and they catch you at a moment where you are hypo, they put you on meds, but when your thyroid goes mad and swings the other way don't you end up feeling awful? Do meds need to be adjusted all the time if you have hashi? Or is simply that taking the meds makes your thyroid stable and calms it down?

2 Replies

Admittedly I don't remember much as I was only 7 when I was (finally) diagnosed with hashi but once I started levothyroxine I had very regular blood tests for quite a while until I was deemed stable I believe. But, I'm almost certain I wasn't diagnosed till my thyroid had completely packed in so no risk of hyper...

With hashi when your thyroid first starts being attacked it can swing back and forth but eventually your thyroid sustains so much damage that you just end up hypo always.


Hashi's do swing from hyper to hypo but it isantibodies attacking the thyroid gland. If you have high antibodies some doctors don't treat till hypo develops but Dr Toft of the British Thyroid Association says:-

2 I often see patients who have an elevated TSH but normal T4. How should I be managing them?

The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.

But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up.

Treatment should be started with levothyroxine in a dose sufficient to restore serum TSH to the lower part of its reference range. Levothyroxine in a dose of 75-100µg daily will usually be enough.


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